Dr. Bronas is a Clinical Exercise Physiologist and a Clinical Assistant Professor in the School of Nursing at the University of Minnesota. The purpose of this proposal is to develop Dr. Bronas into an independent clinical researcher with the long-term goal of conducting clinical research using therapeutic lifestyle interventions in the primary and secondary prevention of renal disease related cardiovascular disease. The career development plan consists of a multi-disciplinary approach to foster a translational and inter-disciplinary approach to clinical research. The training program is designed to provide Dr. Bronas with a closely mentored patient-oriented clinical research experience with structured didactics and course work. The primary mentorship will be provided by Drs. Painter and Rosenberg with cardiologists, nephrologists, and clinical trial experts making up the mentoring advisory committee. The objective of the proposed research is to test the hypothesis that a supervised exercise therapy program (n=40) will improve vascular (endothelial) function, arterial structure (stiffness/compliance), and vascular health biomarkers in men and women with pre-dialysis type 2 diabetic kidney disease (DKD), as compared to a usual medical care control group (n=40). This study will further test the hypothesis that a supervised exercise therapy program will improve physical function. This study is investigating an adjunct treatment option (exercise therapy) previously not studied in patients with DKD and which is not a routine part of clinical practice. The proposed study will be the first to investigate the effect of exercise therapy on vascular health factors that are related to the progression of CVD in patients with DKD and if successful, offer a valuable insight into the efficacy of exercise training as an adjunct therapeutic option for patients with DKD. RELEVANCE: This study is significant because it will be the first study to investigate the impact of exercise therapy on vascular health in patients with DKD. This study will increase our understanding of the utility of exercise therapy to improve vascular health in this population, and generate new hypotheses regarding the impact of exercise therapy on factors associated with the progression of CVD in patients with DKD, and thus provide insight into a new and adjunct treatment option.